Circulation: Heart Failure Editors’ Picks

Abstract

Summary: Recent surveys suggest that up to half of patients with heart failure have a preserved ejection fraction. In this condition, which is associated with poor outcome and in particular a high rate of rehospitalization, identification of factors predicting mortality or morbidity remains largely unexplored, in contrast to patients with heart failure and low ejection fraction. The authors evaluated data from 4128 patients in the I-PRESERVE trial (Irbesartan in Heart Failure with Preserved Ejection Fraction Study). They report an analysis identifying clinical, demographic, and biological factors associated with the primary end point outcome (all-cause mortality or cardiovascular hospitalization), all-cause mortality, and heart failure death or hospitalization. They found that log N-terminal pro–B-type natriuretic peptide, age, diabetes mellitus, previous hospitalization for heart failure, ejection fraction, and other simple clinical or biological variables were associated with a more unfavorable outcome. The models were able to identify subgroups of patients at very high and very low risk. This analysis provides new tools for the prognostic evaluation of heart failure with preserved ejection fraction and the factors that should be taken into consideration when assessing the prognosis of patients with heart failure and preserved ejection fraction. Conclusions: In a large sample of elderly patients with HF and preserved EF enrolled in I-Preserve, simple clinical, demographic, and biological variables were associated with outcome and identified subgroups at very high and very low risk of events.1 Summary: The medical treatment of asymptomatic patients with severe aortic valve regurgitation (AR) remains controversial. No pharmacological treatment has been clearly shown to be effective to protect the myocardium against the deleterious effects of chronic volume overload. Despite the recent publication of promising human data, β-blockade in chronic AR remains controversial because of the deleterious effects of bradycardia. More data are needed to support this potentially new treatment strategy. …